O3437 FRACTURE DISTRACTION FOLLOWING INTRAMEDULLARY NAIL INSERTION: ANOTHER SIGNIFICANT RISK FACTOR FOR ACUTE COMPARTMENT SYNDROME

Abstract

Aims: To assess the effects of the various stages of intramedullary (IM) nailing of the tibia upon intracompartmental pressure (ICP) measurements, including new factors such as fracture impaction. Methods: Anterior compartment pressure monitoring was performed on 25 consenting patients undergoing IM nailing for tibial shaft fractures, using a sensitive transducer-tipped pressure monitor. Results: Signiþcant peaks in ICP, up to 130mmHg, occurred during reaming and nail insertion. Although the ICPs recorded post-operatively (32.79mmHg; range 10 to 68mmHg) were higher than the initial recordings (25.83mmHg; range 8 to 61mmHg), the change was not statistically signiþcant. Reduction of ICP was achieved through release of the traction, but the greatest drop in ICP followed impaction of the fracture after distal cross screw insertion (mean drop 21.75mmHg; range 5 to 58mmHg; p< 0.01). Conclusions: Using the various criteria for diagnosing acute compartment syndrome (ACS), some of our patients either had, or were at considerable risk of developing ACS postoperatively. Furthermore, if fracture impaction had not been performed where necessary, the subsequent sustained increase in ICP would have resulted in additional patients fulþlling the diagnostic criteria for ACS. Clearly, this observation may explain the tendency for some distracted fractures to fail to unite as a result of ischaemia, but of greater signiþcance is the potential for ACS to occur in the postoperative period, leading to signiþcant long term complications.